Crisis in access to mental health care

In this day of doctor shortages and waiting lists, our health has become an area of life where now more than ever it is important to be proactive and to know how to access appropriate services. When seeking mental health care, your family doctor is still your first line of treatment.

However, since there is a large shortage of family doctors due to government intervention and attempts to control spending by reducing the number of doctors, family practice has changed.

It is now less common for a family doctor to take a comprehensive medical history during regular appointments. Unfortunately their fee schedule has evolved in a way that does not adequately remunerate them for the time it would take to take a comprehensive medical history. As a result, if an individual visits his or her doctor with an unrecognized symptom of depression such as fatigue, insomnia or headache, it may not be recognized as such. Now the responsibility for recognizing these things falls more to the patients themselves.

Your family doctor can help you if you ask the right questions, but if not the outcome of a visit may not be satisfactory. If you think you have a psychiatric illness such as depression and you would like to receive specialist treatment from a psychiatrist, this can be arranged by your family doctor. However, it may not be offered if you do not request it specifically.

Treatment from a psychiatrist is covered by MSP at no direct charge to you. Unfortunately, shortages do exist in psychiatry as in all other specialties because of deliberate underfunding of training programs by government in an attempt to control health care costs. There will likely be a waiting period before you can get an appointment to see a psychiatrist.

Right now in Kelowna there is a crisis in access to psychiatric services. There are no psychiatrists accepting new patients and the waiting lists are very long. Even admission to hospital has become very difficult. Recently it has not been unusual for patients admitted through the Emergency Room to never get to the psychiatric ward. They spend several days in the Emergency Room, get frustrated and end up being discharged without any significant treatment or change in their condition. This is the worst access to psychiatric care I have seen it in 27 years. This is unacceptable and reflects problems in the administration of psychiatric services.

If you schedule an appointment to see a psychiatrist, make sure not to miss that appointment. Since services are in demand, there are usually long waiting lists and you might find it is difficult to get another appointment if you don’t attend the one you are given. As with any other doctor, when an appointment is booked, the psychiatrist sets aside a block of time to meet with you. If you don’t show up, the specialist is not paid for that time as most specialists are paid on a fee for service basis and only when actually seeing a patient in person. Psychiatrists do not get paid for telephone or email advice, so don’t expect to replace an appointment with a telephone call.

Psychiatric treatment does not usually require continuous visits to the specialist. Usually, the psychiatrist will make a diagnosis, initiate a treatment plan, educate you about your condition and then arrange for you to be followed by your family doctor or a mental health worker. You may only require a future psychiatric visit if a new problem develops.

It is important for you to remain as up to date as you can on health issues and to seek help when appropriate. Arm yourself with information and bring specific questions and requests to your health care professional. Gone are the days when you can expect to rely totally on your family doctor to direct your care.

 

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